Blood Routine
Examination
Blood tests are used to determine
physiological and biochemical states
such as disease, mineral content,
drug effectiveness, and organ
function.
Cellular evaluation
Full blood count (or "complete blood count")
Hematocrit and MCV ("mean corpuscular volume")
Erythrocyte sedimentation rate (ESR)
Cross-matching. Determination of blood type for
blood transfusion or transplants
Blood cultures are commonly taken if infection is
suspected. Positive cultures and resulting sensitivity
results are often useful in guiding medical treatment
Complete Blood Count
The complete blood count is the calculation
of the cellular (formed elements) of blood
These calculations are generally
determined by specially designed
machines that analyze the different
components of blood in less than a minute
The complete blood count (also called CBC)
is generated by testing a simple blood
sample.
Components of CBC
White blood cell count (WBC)
The number of white blood cells in a volume
of blood
Normal range varies between 4,300 and
10,800 cells per cubic millimeter (cmm)
This can also be referred to as the leukocyte
count and can be expressed in international
units as 4.3 - 10.8 x 109 cells per liter
Automated white cell differential
A machine generated percentage of the different types of white
blood cells, usually split into granulocytes, lymphocytes,
monocytes, eosinophils, and basophils
Neutrophil 27.5x109/L 45-54 — 62-74 % of WBC
Lymphocytes 1.34x109/L 16-25 ---- 33-45 % of WBC
Monocytes 0.20.8x109/L 3-4 -----7-10 % of WBC
Eosinophil 0.040.4x109/L 13-7 % of WBC
Basophil 0.010.1x109/L 0.00.75-2 % of WBC
Red cell count (RBC)
The number of red blood cells in a
volume of blood
Normal range varies between 4.2 - 5.9
million cells/cmm
This can also be referred to as the
erythrocyte count and can be expressed
in international units as 4.2 - 5.9 x 1012
cells per liter
Hemoglobin (Hb)
The amount of hemoglobin in a volume of blood
Hemoglobin is the protein molecule within red blood cells
that carries oxygen and gives blood its red color
Normal range for hemoglobin is different between the
sexes and is approximately 13 - 18 grams per deciliter
for men and 12 - 16 for women (international units 8.1 -
11.2 millimoles/liter for men, 7.4 - 9.9 for women)
Hematocrit (Hct)
The ratio of the volume of red cells to
the volume of whole blood
Normal range for hematocrit is
different between the sexes and is
approximately 45 - 52% for men and
37 - 48% for women
Mean cell volume (MCV)
The average volume of a red cell
This is a calculated value derived
from the hematocrit and red cell
count
Normal range is 86 - 98 femtoliters
Mean cell hemoglobin (MCH)
The average amount of hemoglobin in
the average red cell
This is a calculated value derived from
the measurement of hemoglobin and the
red cell count
Normal range is 27 - 32 picograms
Mean cell hemoglobin concentration
(MCHC)
The average concentration of
hemoglobin in a given volume of red
cells
This is a calculated volume derived from
the hemoglobin measurement and the
hematocrit
Normal range is 32 – 36 g/dl.
Red cell distribution width (RDW)
A measurement of the variability of red cell
size
Higher numbers indicate greater variation in
size
Normal range is 11 – 15%
Platelet count
The number of platelets in a volume blood
Platelets play a vital role in blood clotting
Normal range varies slightly between laboratories
but is in the range of 150,000 - 400,000/ cmm
(150 - 400 x 109/liter)
Indication for CBC
The complete blood count (CBC) is a screening test,
used to diagnose and manage numerous diseases
It can reflect problems with fluid volume (such as
dehydration) or loss of blood
It can show abnormalities in the production, life span,
and destruction of blood cells
It can reflect acute or chronic infection, allergies, and
problems with clotting.
The CBC test isolates and counts the six types of cells
found in the blood: eosinophil, neutrophil, band cell,
red blood cell, lymphocyte, and monocyte
Procedure
A CBC requires a simple blood drawing
Blood is drawn from a vein, usually from the inside of the
elbow or the back of the hand
When the needle is inserted to draw blood, some people
feel moderate pain, while others feel only a prick or
stinging sensation
After the blood is drawn, there may be some throbbing
There are a few slight risks associated with a CBC:
1. Excessive bleeding
2. Fainting or feeling lightheaded
3. Hematoma (blood accumulating under the skin)
4. Infection (a slight risk any time the skin is broken)
5. Multiple punctures to locate veins
Results:
Normal values vary with altitude and gender.
Low numbers of red blood cells may indicate:
Blood loss
Anemia (various types)
Hemorrhage
Bone marrow failure (for example, from radiation, toxin,
fibrosis, tumor)
Erythropoietin deficiency (secondary to renal disease)
Hemolysis (RBC destruction) from transfusion reaction
Leukemia
Multiple myeloma
Malnutrition (nutritional deficiencies of iron, folate,
vitamin B12, vitamin B6)
Over hydration
High numbers of red blood cells
may indicate:
Low oxygen tension in the blood
Congenital heart disease
Cor pulmonale
Pulmonary fibrosis
Polycythemia vera
Dehydration (such as from severe diarrhea)
Renal (kidney) disease with high
erythropoietin production
Low numbers of white blood cells
(leukopenia) may indicate:
Bone marrow failure (for example, due to
granuloma (granular tumor), tumor, or
fibrosis)
Presence of cytotoxic substance
Collagen-vascular diseases (such as lupus
erythematosus)
Disease of the liver or spleen
Radiation exposure
High numbers of white blood cells
(leukocytosis) may indicate:
Infectious diseases
Inflammatory disease (such as
rheumatoid arthritis or allergy)
Leukemia
Severe emotional or physical stress
Tissue damage (for example, burns)
A low hematocrit may indicate:
Anemia (various types)
Blood loss (hemorrhage)
Bone marrow failure (for example, due to
radiation, toxin, fibrosis, tumor)
Hemolysis (RBC destruction) related to
transfusion reaction
Leukemia
Malnutrition or specific nutritional
deficiency
Multiple myeloma
Over hydration
Rheumatoid arthritis
A high hematocrit may indicate:
Dehydration
Burns
Diarrhea
Eclampsia
Erythrocytosis
Polycythemia vera
Shock
Low hemoglobin values may indicate:
Anemia (various types)
Blood loss
ESR
The erythrocyte sedimentation rate (ESR), also called a
sedimentation rate is the rate at which red blood cells precipitate
in a period of 1 hour
It's a common haematology test which is a non-specific measure of
inflammation
To perform the test, anticoagulated blood is placed in an upright
tube, known as a Westergren tube and the rate at which the red
blood cells fall is measured and reported in mm/h.
The red cells form stacks called 'rouleaux' which settle faster
The ESR is increased by any cause or focus of inflammation. The ESR
is decreased in sickle cell anemia, polycythemia, and congestive
heart failure. The basal ESR is slightly higher in females
ESR Age (years) 20 55 90
Men 10 14 19
Women 15 21 23
Cross-matching
A blood type (also called a blood group) is a
classification of blood based on the presence or absence of
inherited antigenic substances on the surface of red blood
cells (RBCs)
ABO and Rh blood grouping
Cross-matching, refers to the testing that is
performed to determine the compatibility of a
donated unit of blood with its intended recipient
Cross-matching is done by a qualified
laboratory technologist in a blood bank, and can
be done electronically, with a computer
database, or serologically
Blood culture
Blood culture is microbiological culture of blood
It is employed to detect infections that are spreading
through the bloodstream (bacteremia, septicemia)
Microbial organisms multiply and reproduce in
predetermined culture media under controlled
laboratory conditions
Blood culture are used to determine the type of
organism, its abundance in the sample being tested,
or both
Biochemical analysis
A basic metabolic panel measures
sodium, potassium, chloride,
bicarbonate, blood urea nitrogen
(BUN), magnesium, creatinine, and
glucose. It also sometimes includes
calcium
Normal Ranges
Sodium (Na) 136-145mmol/L
Potassium (K) 3.5-4.5mmol/L
Urea 2.5-6.4 mmol/L BUN - blood urea nitrogen
Urea 7-18mg/dL
Creatinine – male 62-115μmol/L or 0.7-1.3mg/dL
Creatinine – female 53-97μmol/L or 0.6-1.1mg/dL
Glucose (fasting) 3.9-5.8mmol/L
Glucose (fasting) 70- 105mg/dL
Some blood tests, such as measuring glucose, cholesterol
or for STD screening require fasting (or no food
consumption) eight to twelve hours prior to the blood test
While the regular glucose test is taken at a certain point in
time, the glucose tolerance test involves repeated testing
to determine the rate at which glucose is processed by the
body
For the majority of blood tests, blood is usually obtained
from the patient's vein. However, other specialized blood
tests, such as the Arterial blood gas, require blood
extracted from an artery
Arterial blood gas analysis
Blood gas analysis of arterial blood
is primarily used to monitor carbon
dioxide and oxygen levels related to
pulmonary function. But, it is also
used to measure blood pH and
bicarbonate levels for certain
metabolic conditions.
Molecular profiles
Protein electrophoresis (general technique -- not a
specific test)
Western blot (general technique -- not a specific test)
Liver function tests
Polymerase chain reaction (DNA). DNA testing is today
possible with even very small quantities of blood: this is
commonly used in forensic science, but is now also part
of the diagnostic process of many disorders.
Northern blot (RNA)
Sexually transmitted diseases
